| |
2080 N Main St, Longmont, CO 80501-1916 | |
(303) 651-2020 | |
(303) 776-2460 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 2080 N Main St, Longmont, Colorado |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1730299116 | NPI | - | NPPES |
04008959 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Primary |
Provider Name | Gina Gabriel |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1902889637 PECOS PAC ID: 2961401948 Enrollment ID: I20061221000046 |
Provider Name | Rachel A Potter |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1730387374 PECOS PAC ID: 6103910823 Enrollment ID: I20070925000574 |
Provider Name | Jaclyn M Wray |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1194089060 PECOS PAC ID: 4385893312 Enrollment ID: I20121005000430 |
Provider Name | Justin D Deal |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1134400054 PECOS PAC ID: 2668618919 Enrollment ID: I20130411000484 |
Provider Name | Kristin Park |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1164046629 PECOS PAC ID: 9638580855 Enrollment ID: I20201119001175 |
Mailing Address | Practice Location Address |
---|---|
2080 N Main St, Longmont, CO 80501-1916 Ph: (303) 651-2020 | 2080 N Main St, Longmont, CO 80501-1916 Ph: (303) 651-2020 |
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